Carpal tunnel syndrome (CTS) is a common median nerve compression syndrome and the most common peripheral mononeuropathy. The clinical syndrome is diagnosed by history and physical examination. Electrodiagnostic testing is the objective method used to measure median nerve dysfunction at the wrist and confirm the clinical diagnosis of CTS. Neuromuscular ultrasound imaging of the carpal tunnel provides supportive diagnostic information by revealing pathologic nerve swelling in CTS, and other anatomic anomalies that compress the median nerve. These tests cannot be used to make the diagnosis in the absence of history that includes CTS symptom criteria and excludes other causes.
Carpal tunnel syndrome is a painful disorder of the hand caused by pressure on nerves that run through the wrist. Symptoms include numbness, pins and needles, and pain (particularly at night). Anything that causes swelling inside the wrist can cause carpal tunnel syndrome, including repetitive hand movements, pregnancy, and arthritis. Possible treatments include rest, splinting, cortisone injections, and surgery.
Anatomy of Carpal Tunnel Syndrome
The carpal tunnel is composed of a bony canal, consisting of carpal bones, the roof of which is the fibrous but rigid transverse carpal ligament. The carpal tunnel contains the nine flexor tendons and the median [rx], which enters the tunnel in the midline or slightly radial to it [rx]. Atypical presentations could be explained by anatomical variations in the median nerve itself [rx].
Sensory branches from the median nerve supply the 3 radial digits and the radial half fourth digit – hence why CTS symptoms are felt in these fingers. The palmar sensory cutaneous branch of the median nerve supplies the cutaneous skin of the palm, and arises, on average, 6 cm proximal to the transverse carpal ligament (TLC). Therefore, the palm is generally not affected in CTS [rx].
The carpal tunnel is a narrow passageway in the wrist, which opens into the hand. It is surrounded by the bones of the wrist (underneath) and the transverse carpal ligament (across the top). The median nerve runs through the carpal tunnel and gives feeling to the thumb, forefinger, middle finger, and half of the ring finger.
Many tendons also pass through this carpal tunnel and if any swelling occurs, the large median nerve can easily be compressed, causing carpal tunnel syndrome.
Flexor tendons run through the carpal tunnel into the hand. These tendons are covered by a smooth membrane called the tenosynovium and allow hand movement. Any thickening from inflamed tendons or other causes of swelling can reduce the amount of space inside the carpal tunnel. If left unchecked, the median nerve is squashed against the transverse carpal ligament until the nerve cannot function properly. Numbness and pain are the results. It can affect one or both hands.
The muscles of the thumb are also serviced by the median nerve. A person with advanced carpal tunnel syndrome may find they cannot properly use or move their thumb anymore and may find it difficult to grasp an object.
Causes of Carpal Tunnel Syndrome
In some cases, the cause cannot be found. Sometimes there is a combination of factors such as
- Arthritis – various types of arthritis, especially rheumatoid arthritis, can cause inflammation and swelling
- Pregnancy – the hormones associated with pregnancy cause general fluid retention, which can compress the nerve. Carpal tunnel syndrome triggered by pregnancy usually goes away soon after birth
- Wrist fractures – bone fragments can irritate the tenosynovium or reduce the amount of space in the carpal tunnel
- Congenital factors – some people have a smaller carpal tunnel than others
- Overuse injury – the tendons in the carpal tunnel can become irritated and inflamed by awkward postures or repetitive hand movements.
*According to the American Academy of Neurology’s guidelines
Conditions that may be confused with carpal tunnel syndrome
Cervical radiculopathy (especially C6/7)—look for local neck pain on movement and neurological signs outside the territory of the distal median nerve
Ulnar neuropathy—this can also produce nocturnal paraesthesias; the distribution will usually be to the medial side of the hand.
Raynaud’s phenomenon—this should be recognizable from a history of symptoms related to cold exposure
Vibration white finger—suspect this if the patient uses vibrating hand tools at work
Osteoarthritis of the metacarpophalangeal joint of the thumb—this can produce a spurious appearance of thenar wasting but not true weakness or sensory deficit
Tendonitis—specific tests may help in diagnosis, such as Finkelstein’s test for De Quervain’s tenosynovitis
Generalized peripheral neuropathies—these should be recognized from the wider distribution of symptoms and reflex changes
Motor neuron disease—this can present with wasting in one hand but does not produce sensory symptoms
Syringomyelia—features such as prominent loss of temperature sensation in the hands should give a clue
Multiple sclerosis—this should be recognized from the presence of neurological abnormalities disseminated in location and time
- Cervical radiculopathy – especially C6 or C7 radiculopathy, which commonly results in numbness of the thumb, index finger, or middle finger. Sensory symptoms or signs above the wrist, unilateral radicular pain exacerbated by neck movements, segmental weakness in the arm and forearm, or myotatic reflex asymmetry favors radiculopathy.
- Neurogenic thoracic outlet syndrome – which frequently is associated with thenar atrophy. However, the pain and sensory manifestations in neurogenic thoracic outlet syndrome are in a C8/T1 distribution (ring and little fingers and medial aspect of the forearm).
- Peripheral polyneuropathy – which may be associated with hand numbness. However, there are often sensory manifestations and motor weakness in the legs. Also, there usually is hyporeflexia or areflexia, especially at the ankles.
- High median mononeuropathy – including the pronator syndrome, and compression at the ligament of Struthers in the distal arm. Both are rare syndromes and usually are associated with weakness of the long finger flexors.
- Cervical myelopathy – In this condition, the numbness is not restricted to the median nerve, and there are frequently other pyramidal manifestations.
Risk factors of Carpal Tunnel Syndrome
Some people are at higher risk of developing carpal tunnel syndrome, including
- Women between the ages of 40 and 60 years
- Pregnant women
- People with certain types of arthritis
- Anyone who experiences a period of rapid weight gain
- People who use their hands repetitively in their day-to-day activities, such as typists or assembly line workers.
Symptoms of Carpal Tunnel Syndrome
Abnormal sensations – Parts of the hand feel numb or may tingle (also called “pins and needles”). Usually, the thumb and the middle three fingers are affected (these appear red in the illustration). Your hand falling asleep at night could be a typical early sign of carpal tunnel syndrome.
Pain in your fingers – Sometimes the entire hand might also hurt, or the pain may radiate into your arm.
- Pins and needles
- Pain, particularly at night
- Darting pains from the wrist
- Radiated or referred pain into the arm and shoulder
- The weakness of the hand
- The little finger and half of the ring finger are unaffected.
Standard symptoms of carpal tunnel syndrome*
Dull, aching discomfort in the hand, forearm, or upper arm
Paraesthesias in the hand
Weakness or clumsiness of the hand
Dry skin, swelling, or color changes in the hand
The occurrence of any of the above in the median distribution
Provocation of symptoms by sleep
Provocation of symptoms by sustained hand or arm positions
Provocation of symptoms by repetitive actions of the hand or wrist
Mitigation of symptoms by changing hand posture or shaking the wrist
Diagnosis of Carpal Tunnel Syndrome
Physical Assessment Tests for Carpal Tunnel Syndrome
The best of these include the carpal compression test. This is done by applying firm pressure directly over the carpal tunnel for 30 seconds. The test is positive when paresthesias, pain, or other symptoms are reproduced.
- Flick Signal – One important and simple test of carpal tunnel is the “flick” signal. The patient is asked, “What do you do when your symptoms are worse?” If the patient responds with a motion that resembles shaking a thermometer, the doctor can strongly suspect carpal tunnel.
- Testing for Thumb Weakness – Two questions are useful in determining thumb weakness, Can the thumb rise up from the plane of the palm? Can the thumb stretch so that its pad rests on the little finger pad?
- Phalen’s Test – In Phalen’s test, the patient rests the elbows on a table and lets the wrists dangle with fingers pointing down and the backs of the hands pressed together. If symptoms develop within a minute, CTS is indicated. (If the test lasts for more than a minute, even patients without CTS may develop symptoms.) This test may be particularly important in determining the severity of CTS and assessing the results of treatment.
- Tinel’s Sign – In the Tinel’s sign test, the doctor taps over the median nerve to produce a tingling or mild shock sensation.
- Pressure Provocation Test – The doctor presses over the carpal tunnel for 30 seconds to produce tingling or shock in the median nerve.
- Tourniquet Test – This test uses an inflatable cuff that applies pressure over the median nerve to produce tingling or small shocks.
- Hand Elevation Test – The patient raises his or her hand overhead for 2 minutes to produce symptoms of CTS. The test was has been proven to be accurate and may provide useful information when combined with the Tinel’s and Phalen’s tests.
- The reverse Phalen’s, or ‘prayer test,’ – is done by having the patient extend both of their wrists by placing palmar surfaces of both hands together for 1 minute (as if praying). Again a positive test is with the reproduction of symptoms.
- The reverses prayer Test – is performed by having the patient fully flex their wrists by placing dorsal surfaces of both hands for one minute. A positive test is when symptoms (numbness, tingling, pain) are reproduced.
The square sign test – is an evaluation to determine the risk of developing carpal tunnel syndrome. The test is positive if the ratio of the thickness of the wrist divided by the width of the wrist is great than 0.7.
- X-rays – X-rays of the affected extremity at the elbow and wrist should be obtained to rule out any osseous deformity that may cause nerve entrapment, as well as cervical spine radiographs that may reveal sources of radiculopathy or first rib involvement. Finally, a chest x-ray should be obtained to rule out compression of the medial chord by an apical lung or Pancoast tumor, particularly in a patient with a positive history for smoking.
- Plain radiographs – May be useful during instances where there is a history of trauma, or there is suspicion of a fracture. It can also help to identify cases of osteoarthritis, bony prominences or osteophytes, and the presence of orthopedic hardware that could compress nerves.
- Ultrasound – of the nerve at the elbow and wrist can be used to measure the size of the radial nerve compared to controls, as well as to identify a thrombosis of the radial artery that can lead to ulnar nerve symptoms originating in Guyon’s canal.[rx]
Electrodiagnostic studies – Electromyography and nerve conduction studies help to localize the nerve involved as well as where along the course of the nerve it is affected. Additionally, testing can serve as a baseline for comparison with future studies during the course of treatment. It is important to note that normal electrodiagnostic studies do not rule out disease, and clinical correlation should include the patient’s history and physical examination findings.
Magnetic Resonance Imaging (MRI) – Can be useful in the identification of ganglion cysts, synovial or muscular hypertrophy, edema, vascular disease, as well as nerve changes. The cross-sectional area and space available for the nerve can also be measured and compared to accepted normal values.
Nerve ultrasonography – The use of nerve ultrasonography has increased recently. It can measure the cross-sectional area and the longitudinal diameter of the nerve. It can also identify compressive lesions. Ultrasound may also evaluate the presence of local edema. Additionally, ultrasound may help distinguish between different causes of wrist pain that can include tendonitis or osteoarthritis.
Serologic studies – There are no blood tests used to specifically support the diagnosis of nerve compression, but the use of these tests may be necessary for medical conditions that can either promote nerve compression or can mimic their symptoms. Some of the most frequently encountered conditions include diabetes and hypothyroidism. The assessment of a patient’s fasting blood glucose, hemoglobin A1c, or thyroid function tests may be helpful in the general management of the patient. Other conditions that could mimic nerve compression include deficiency of vitamin B12 or folate, vasculitides, and fibromyalgia.
Electromyography – is also commonly used in the diagnosis of compression neuropathy with muscle denervation. Compressive neuropathies result in increased distal latency and decreased conduction velocity. Thus in patients with cubital tunnel syndrome, one is likely to identify a slowing of conduction in the ulnar nerve segment crossing the elbow.[rx][rx]
Both ultrasonic scanning (USS) – and magnetic resonance imaging (MRI) have sensitivity and specificity over 80% in diagnosis. MRI and USS are also helpful to identify other causes of compression, which may not be picked up on plain radiograph films such as soft tissue swelling and lesions such as neuroma, ganglions, aneurysms, etc.[rx]
Electrodiagnostic tests – analyze the electric waves of nerves and muscles. These tests can help detect median nerve compression in the carpal tunnel.
Electrodiagnostic tests – should be used if clinical or provocative tests are positive and the patient is considering surgery. These tests are the best methods for confirming a diagnosis of CTS. Doctors who perform these tests should be certified by the American Board of Electrodiagnostic Medicine, which uses rigorous standards in qualifying doctors. Specific electrodiagnostic tests called nerve conduction studies and electromyography, are the most common ones performed. Nerve conduction tests can also detect other problems that cause CTS symptoms, such as pinched nerves in the neck or elbow, or thoracic outlet syndrome.
- Nerve Conduction Studies – To perform nerve conduction studies, surface electrodes are first fastened to the hand and wrist. Small electric shocks are then applied to the nerves in the fingers, wrist, and forearm to measure how fast a signal travels through the nerves that control movement and sensation. Nerve conduction tests are fairly accurate when done on patients with more clear-cut symptoms of carpal tunnel syndrome. They are less accurate in identifying mild CTS, however. Patients should be sure their practitioners perform tests that compare a number of internal responses, not just the responses of muscles located in the palm at the base of the thumb. They should also make sure the tests measure responses on the second or third fingers.
- Electromyography – To perform electromyography, a thin, sterile wire electrode is inserted briefly into a muscle, and the electrical activity is displayed on a viewing screen. Electromyography can be painful and is less accurate than nerve conduction. Some experts question whether it adds any valuable diagnostic information. They suggest that its use is limited to unusual cases, or when other tests indicate that the condition is aggressive and may increase the risk for rapid, significant injury.
- Portable electrodiagnostic testing – Portable electronic devices are being evaluated for measuring nerve conductivity. They are relatively quick and easy to use on a large scale in an industrial facility. However, these devices have not been not well studied in clinical trials.
Electrodiagnostic studies are not well standardized, and certain conditions can skew the results of either test:
- Obesity can slow the speed of electrical conduction.
- Women and the elderly normally have slower conduction times than younger adult men.
A diagnosis of carpal tunnel syndrome may follow testing the affected hand for numbness, tingling, weakness or pain in specific areas. Muscle and nerve conduction tests may also help affirm or rule out carpal tunnel syndrome.
Treatment of Carpal Tunnel Syndrome
The improvements last for more than 6 months. Even among patients with mild CTS, there is a high risk of relapse. Some researchers are reporting better results when specific exercises for carpal tunnel syndrome are added to the program of treatments.
- Ice – Ice may help with acute pain. Some patients have reported that alternating warm and cold soaks is beneficial. (If hot applications relieve pain, most likely the problem is not caused by CTS but by another condition that produces similar symptoms.)
- Limiting Movement – If possible, the patient should avoid activities at work or home that may aggravate the syndrome. The affected hand and wrist should be rested for 2 – 6 weeks. This allows the swollen, inflamed tissues to shrink and relieves pressure on the median nerve. If the injury is work-related, the worker should ask to see if other jobs are available that will not involve the same hand or wrist actions. Few studies have been conducted on ergonomically designed furniture or equipment, or on frequent rest breaks. However, it is reasonable to ask for these if other work is not available.
- Physiotherapy – It is one of the most common and effective non-pharmacological treatments in the world. It has a variety of treatment modules to erase acute and chronic pain. It is especially helpful in muscle spasticity, spasms related to carpal tunnel syndrome. Inflammatory and noninflammatory pain is treated by ultrasound, MRI, Shortwave, microwave, wax therapy, IRR, laser therapy, interferential current therapy, iontophoresis. Some studies have reported good outcomes with physiotherapy regimes of stretching and strengthening, with more favorable results than rest and reduced activity at short-term follow-up.[rx]
- Deep transverse friction massage – It is a special type of massage technique called transverse friction massage is often used to treat carpal tunnel syndrome patients. It is applied to the tendons and the muscles, using the tips of one or two fingers to heal carpal tunnel syndrome.
- Transcutaneous electrical nerve stimulation (TENS) – It is called TENS devices that help to transfer electrical impulses that are helpful for the treatment of carpal tunnel syndrome to the nervous system through the skin. These are supposed to keep the pain signals from reaching the brain by blocking pain message signals.
- Extracorporeal shockwave therapy (ESWT) – It is a physiotherapy device that generates shock or pressure waves that are transferred to the tissue through the skin for healing carpal tunnel syndrome. This is assumed that to improve the circulation of blood in the tissue and speed up the healing process
- Wrist Splints – Wrist splints can keep the wrist from bending. They are not as beneficial as surgery for patients with moderate-to-severe CTS, but they appear to be helpful in specific patients, such as those with mild-to-moderate nighttime symptoms that have lasted for less than a year. Typically the splint is worn at night or during sports. The splint is used for several weeks or months, depending on the severity of the problem, and it may be combined with hand and finger exercises. Benefits may last even after the patient stops wearing the splint.
- Ultrasound – Ultrasound uses high-frequency sound waves directed toward the inflamed area. The sound waves are converted into heat in the deep tissues of the hand, opening the blood vessels and allowing oxygen to be delivered to the injured tissue. Ultrasound is often performed along with nerve and tendon exercises. Ultrasound treatment appears to be effective in the short term, but its long-term benefit remains unknown.
- Yoga – Very limited evidence suggests that yoga practice may provide some benefit for patients with carpal tunnel syndrome. Yoga postures are designed to stretch, strengthen, and balance upper body joints.
- General Exercise Program – Some experts have reported that people who are physically fit, including athletes, joggers, and swimmers, have a lower risk for cumulative trauma disorders. Although there is no evidence that exercise can directly improve CTS, a regular exercise regimen using a combination of aerobic and resistance training techniques strengthens the muscles in the shoulders, arms, and back; helps reduce weight, and improves overall health and well-being.
- Low-Level Laser Therapy – Some investigators are working with low-level laser therapy (LLLT), which generates extremely pure light in a single wavelength. The procedure is painless. However, two trials comparing laser therapy to conservative treatment or a placebo laser treatment found no real benefit from this therapy.
- Alternative Therapies – Many alternative therapies are offered to people with carpal tunnel syndrome and other repetitive stress disorders. Few of these therapies have any proven benefit, however. People should learn how alternative therapies may interact with other medications they are taking, or impact other medical conditions they have, and they should check with their doctor before trying any of these therapies.
- Acupuncture – Acupuncture is often used to relieve CTS symptoms. Although the treatment looks promising for symptom relief, there isn’t enough solid research at this point to recommend it for CTS. More studies are needed to evaluate its benefit.
- Chiropractic Therapies – Chiropractic techniques may be helpful for some people whose problems are caused by pinched nerves. There is little evidence, however, to support the use of chiropractic therapies for carpal tunnel syndrome.
- Magnets – Magnets are a popular but unproven therapy for pain relief.
- Over-the-counter drugs – In special circumstances, various medications can reduce the pain, the pain and swelling associated with carpal tunnel syndrome. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, naproxen, aceclofenac, and other nonprescription pain relievers, may provide some short-term relief from discomfort.
- Prescription medicines – The corticosteroids (such as prednisone) or the drug lidocaine can be injected directly into the wrist to healing and remove overpressure in the median nerve or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve in people with mild or intermittent symptoms.
- Vitamin B1, B6, and B12 – It is essential for neuropathic pain management, pernicious anemia, tennis elbow, with vitamin b complex deficiency pain, paresthesia, numbness, itching with diabetic neuropathy pain, myalgia, etc. A side effect may be nausea- vomiting, abdominal pain, cramping
- Nerve relaxant – It is basically used to reduce neuropathic pain, inflammation, nerve root entrapment, myalgia, neuralgia, and fibromyalgia, and carpal tunnel syndrome. Your doctor may prescribe gabapentin, pregabalin, vitamin B1, B6, B12, etc. Major side effects are abdominal pain, nausea- vomiting.
- Lidoderm patches – It is a prescription medicine that is used to reduce pain, swelling, tenderness, paresthesia, itching, numbness, and carpal tunnel syndrome. It has the anesthetic power that is helpful in carpal tunnel syndrome.
- Corticosteroid Injections – Corticosteroids (also called steroids) reduce inflammation. If restricting activities and using painkillers are unsuccessful, the doctor may inject a corticosteroid into the carpal tunnel. In CTS, steroid injections (such as cortisone or prednisolone) shrink the swollen tissues and relieve pressure on the nerve. There is good evidence that they offer short-term symptom relief in a majority of CTS patients. However, in about half of cases, symptoms return within 12 months. Generally, a second injection does not provide any added benefit. Another concern with the use of these injections in moderate or severe diseases is that nerve damage may occur even while symptoms are improving. Most doctors limit steroid injections to about three per year because they can cause complications, such as weakened or ruptured tendons, nerve irritation, or more widespread side effects.
- Low-Dose Oral Corticosteroids – A short course (1 – 2 weeks) of oral corticosteroid medicines may provide relief for some people, but the relief does not usually last. Long-term use of these medications can cause serious side effects.
- Botulinum toxin type A – Intracarpal injections of botulinum toxin type A (Botox) have not been well studied.
Carpal tunnel release surgery is among the most common surgeries performed in the United States. In various trials, 70 – 90% of patients who underwent surgery were free from nighttime pain afterward. Studies have found that surgery provides a greater benefit over the long term compared with splinting or anti-inflammatory drugs plus hand therapy.
Candidates for Surgery
Although evidence strongly suggests that surgery is more effective than conservative approaches (at least in patients with moderate-to-severe CTS), the decision about whether to have surgery to correct CTS and when to have it, is not always clear. Electrodiagnostic and other tests used to confirm CTS are not always perfect or useful in determining the best candidates for surgery.
As a result, surgery does not cure all patients. A number of experts believe that release surgery is performed too often. Some recommend a full trial of conservative treatment (such as splints, anti-inflammatory agents, and physical therapy) before choosing surgery. Others warn that CTS is often progressive and will worsen over time without surgery and that surgery is better than splints and conservative measures for pain relief in cases where carpal tunnel syndrome is likely to present.
Factors that may increase the chances of a successful surgery
- Having surgery performed within 3 years of being diagnosed with the disorder
- Being in good general health
- Having very slow nerve conduction results, but also having reasonably good muscle strength before surgery
- Having symptoms that are worse at night than during the day
Factors that may reduce the chances for success
- Having very severe symptoms before surgery, such as:
- Symptoms that have been present for more than 10 months
- Being over 50 years old
- Performing heavy manual labor, particularly working with vibrating tools. Only slightly more than half of people who use vibrating hand-held tools are symptom-free 3 years after a CTS operation.
- Patients who are on hemodialysis have good initial success, but the condition deteriorates in about half of these patients after around a year and a half.
- Poor mental health or alcohol abuse
Patients with diabetes and high blood pressure may be more likely to require a second operation.
Standard Release Surgical Procedures
CTS surgery can be performed through a standard open release, a mini-open technique, or endoscopy. There is no clear evidence to suggest that one surgical technique is much better than another over the long term.
- Open Release Surgery – Traditionally, surgery for CTS has involved an open surgical procedure performed in an outpatient facility. In this procedure, the carpal ligament is cut free (released) from the median nerve. This relieves pressure on the median nerve. The surgery is straightforward. In treating carpal tunnel syndrome, surgery may be required to release the compressed median nerve. The open release procedure involves simply cutting the transverse carpal ligament.
- The Mini-Open Approach – In recent years, more surgeons have adopted a “mini” open also called short-incision procedure. This surgery requires only a 1-inch incision, but it still allows a direct view of the area (unlike endoscopy, which is viewed on a monitor). The mini-open approach seems to reduce recovery time, pain, and recurrence rate compared to an open approach. However, over the long term, there doesn’t seem to be any significant difference between the mini-open approach and the standard open release.
Endoscopy for carpal tunnel syndrome is a less invasive procedure than standard open release.
- A surgeon makes one or two 1/2-inch incisions in the wrist and palm and inserts one or two endoscopes (pencil-thin tubes).
- The surgeon then inserts a tiny camera and a knife through the lighted tubes.
- While looking at the underside of the carpal ligament on a screen, the surgeon cuts the ligament to free the compressed median nerve.
Patients who have endoscopic surgery report less pain than those who have the open release procedure, and they return to normal activities in about half the time. Nevertheless, at this time the best evidence available does not show any significant long-term advantages of endoscopy over open release in terms of muscle, grip strength, or dexterity. The endoscopic approach may even carry a slightly higher risk of pain afterward. This may be due to a more limited view of the hand with endoscopy. (In the open release procedure, the surgeon has a full view of the structures in the hand.) Because of this reduced visibility, there are more concerns about irreversible nerve injury with endoscopic carpal tunnel release than with open carpal tunnel release. However, larger studies have shown an extremely low number of complications when the procedure is performed by experienced physicians.
Recovery after Surgery
Timing of Recovery
For some patients, release surgery relieves symptoms of numbness and tingling immediately.
- People who have the operation on both hands will need someone to help them at home for about 2 weeks.
- Returning to strenuous work right after surgery may cause the symptoms to return. Patients who work in strenuous jobs generally stay out of work for at least a month and often much longer, depending upon the type of surgery and the severity of the condition. Recovery time appears to be faster with endoscopy or a mini-open release than with open release.
- People who perform light office work will return to work much sooner, although possibly with some limitations.
- Immediately after surgery, patients usually experience a decline in grip strength and dexterity. Studies have reported a wide range of recovery in this area. The scar may remain tender for up to a year.
- Peak improvement (the best level of improvement a patient can reach) may take a long time (up to 10 months).
Physical Therapy. Physical therapy following surgery has not been shown to speed up recovery or affect the final outcome of CTS surgery.
Complications and Long-Term Outcome
Treatment failure and complication rates of CTS surgery vary.
Complications after surgery may include the following:
- Nerve damage with tingling and numbness (usually temporary)
- Loss of some wrist strength is a complication that affects 10 – 30% of patients. Some patients who have jobs requiring significant hand and wrist strength may not be able to perform them after surgery. These workers may also have problems in other parts of the upper body, including the elbows and shoulders. These problems do not go away with surgery and can persist. Studies indicate that 10 – 15% of patients change jobs after a CTS operation.
If pain and symptoms return, the release procedure may be repeated.
Reasons for procedure failure include
- Incomplete release of the ligament
- Extensive scarring
- Recurrence of the disorder due to underlying medical conditions
Patients who had open release surgery appear more likely to require repeat operations compared with those who have had endoscopic surgery.
Immediately after surgery for carpal tunnel syndrome
After the operation, you can expect that
- If you had a general anesthetic, nurses will check your temperature, pulse, breathing, blood pressure and wound site frequently.
- You should not eat anything for at least four hours after the operation.
- Your wrist may be placed in a sling to help reduce swelling.
- Your wrist may be quite painful or uncomfortable for a couple of days. Your doctor will order analgesia (pain-relieving medication).
- You should exercise your hand and wrist as soon as possible, following your doctor’s advice.
Self-care after surgery for carpal tunnel syndrome
Follow your doctor’s advice, but general suggestions include:
- If you go home within a day or two of surgery, you will probably need some help around the house.
- Continue your medication as ordered by your doctor.
- Cold packs applied at regular intervals can help reduce post-operative swelling.
- Rest the hand as much as you can for at least four weeks following surgery.
Long-term outlook after surgery for carpal tunnel syndrome
Your symptoms should ease dramatically after surgery. However, pain around the surgery site may linger for some months. See your doctor if you are concerned about the amount of pain or discomfort. If you have non-absorbable sutures, your doctor will need to remove these about two weeks after the operation. If you have any increased swelling, redness or heat, see your doctor immediately, since these symptoms could indicate infection.
Exercises for Carpal Tunnel Syndrome
|Exercise 3 (Wrist Circle)
|Fingers and Hand||Exercise 1
|Forearms (stretching these muscles will reduce tension in the wrist)||
|Neck and Shoulders||Exercise 1
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